The voluntary
or involuntary passage of stools causing soiling of clothes by a child
over 4 years of age. Encopresis can be divided into two groups.
The first in which there is a physiologic basis for the encopresis,
the second in which there seems to be an emotional basis.
1. Encopresis
frequently is associated with constipation and fecal impaction.
2. Other causes
may be related to a lack of toilet training or training at too early
an age or an emotional disturbance such as Oppositional
Defiant Disorder or a Conduct
Disorder.
Accidentally or on purpose, the patient repeatedly passes feces into
inappropriate places (clothing, the floor).
For at least 3 months, this has happened at least once per month.
The patient is at least 4 years old (or the developmental equivalent).
This behavior is not caused solely by substance use (such as laxatives)
or by a general medical condition (except through some mechanism that
involves constipation).
Associated
Features:
Medical Condition
(bowel infection)
Oppositional Defiant
Disorder
Conduct Disorder
Differential Diagnosis:
Some disorders have similar or even the same symptoms. The clinician,
therefore, in his/her diagnostic attempt, has to differentiate against
the following disorders which need to be ruled out to establish a
precise diagnosis.
Constipation
Fecal impaction
Treatment:
The goal of treatment is to prevent constipation and encourage good
bowel habits. Here counseling and dietary advice is essential.
Parental support
and refrain from criticism or discouragement is important. Education
of the parents and child, and biofeedback for the child is often used.
Psychotherapy can help the child deal with associated shame, guilt,
or loss of self-esteem. As an example, The child may suffer from low
self-esteem and peer disapproval related to this problem. If routine
bowel habits are not developed, the child may suffer from chronic
constipation.
Medical &
Other:
A diet high in
fiber, including fruits, vegetables, and whole grain products and
adequate fluid intake will promote the passage of softer stools and
minimize the discomfort associated with bowel movements. Consultations
with Pediatric Gastroenterologists to treat the more difficult cases.
